The purpose of this proposal is to develop, pilot (R21), and then (R33) utilize a randomized controlled trial to test the comparative effectiveness within a primary care setting of three protocols for older adults e 60 years of age who are not currently wearing hearing aids and who screen positive as at risk for hearing loss on subsequent effective access to and use of hearing health care services. The three protocols include: 1) screening for hearing loss only followed by a statement that the person has possible hearing loss and should obtain a follow-up evaluation (standard care control);2) standard care plus the provision of an illustrated brochure on hearing loss, hearing aids, and assistive listening devices;and 3) standard care plus the provision of an illustrated brochure on hearing loss, hearing aids, and assistive listening devices and an in- person brief educational program on hearing loss, hearing aids and assistive listening devices. The goal is to develop an intervention that: 1) can be easily integrated into primary care settings that serve a range of individuals with varying levels of financial and social resources;2) can be implemented by office or clinic personnel with a wide range of backgrounds;and 3) will promote the effective subsequent access to and use of hearing health care services. Congruent with the mission of the NIDCD to "improve the function and quality of life of individuals with communication disorders," the ultimate goal is to maximize healthy aging and quality of life and minimize cognitive decline by facilitating the ability of older adults to remain socially engaged and highly functional. Many older adults will not raise the issue of hearing loss with their practitioners, partly because it comes on slowly and is not appreciated for its significance. If referred, they often do not accept recommended interventions or do not successfully adapt to the use of hearing aids, often because of poor understanding of age related hearing loss, unrealistic and uninformed expectations about hearing aids, and beliefs that hearing loss is not an important issue and that hearing aids are stigmatizing. Given poor follow-up or subsequent successful use of hearing services, screening in the primary care setting is often not viewed as an effective use of time. To address these issues, the development of a time-efficient, cost-effective, and outcome-effective intervention is needed so that assessment and hearing health education can be integrated into primary care settings with acknowledgment of the constraints of time and cost. This project is designed to develop and test such an intervention and brings together a multi-disciplinary team with expertise in hearing loss, primary care, health literacy and economics that is essential to the successful implementation of the project. PUBLIC HEALTH RELEVANCE: Hearing loss is one of the most common problems experienced by older adults, significantly impacts the well-being of these older adults and their families, and impacts society by preventing them from continuing to remain engaged in community activities and potentially contributing to cognitive decline. Still, many older adults are not screened for hearing loss and do not have appropriate information about hearing loss and assistive technology that would promote their access to and use of hearing health care services. This minimizes their potential to effectively adapt to hearing aids or obtain other nonmedical treatment appropriate to their hearing health needs. This project specifically addresses these issues and thus one of the key goals of Healthy People 2010, to improve the hearing health of the nation through early detection, treatment and rehabilitation, by developing, refining and testing a time-efficient, effective, primary care based screening and educational intervention protocol that will promote subsequent access to and successful use of hearing health care services.